CT anthropometric analysis of the prognosis of traumatic brain injury: A retrospective study to compare between psoas muscle and abdominal skeletal muscle.

BACKGROUND: Recent studies have suggested that skeletal muscle area (SMA) and psoas muscle area (PMA), markers for sarcopenia, are associated with the prognosis of many diseases. However, it remains unclear which of the two is a superior prognostic marker. Thus, the objective of this study was to analyse these markers in patients with traumatic brain injury (TBI). METHODS: Patients with TBI [abbreviated injury scale (AIS) score of 4 or 5] were selected. Those with an AIS score of 4 or 5 for chest, abdomen, or extremity lesion were excluded. Clinical data, including Glasgow Outcome Scale (GOS), mortality, and anthropometric data, were collected. SMA and PMA were measured. Skeletal muscle index (SMI) and psoas muscle index (PMI) were calculated for each muscle area divided by height squared. The good prognosis group was defined as patients with a GOS score of 4 to 5. The poor prognosis group was defined as those with a GOS score of 1-3. Data of both groups were analysed for the overall prognosis. After excluding patients with a hospital stay of 1 or 2 days, the modified prognosis and mortality of patients were analysed. RESULTS: A total of 212 patients were enrolled in the statistical analysis. Patients with good prognosis showed a larger PMA (17.4 cm2 vs. 15.0 cm2, P = 0.002) and PMI (6.1 cm2/ m2 vs. 5.3 cm2/ m2, P = 0.001). After modification, patients with good prognosis showed a larger PMA (17.4 cm2 vs. 14.9 cm2, P = 0.002) and PMI (6.1 cm2/ m2 vs. 5.3 cm2/ m2, P = 0.01). On binary logistic regression analysis, PMI was found to be a significant risk factor for the modified prognosis (Odds ratio (OR) (95% confidence interval (CI)): 0.763 (0.633 - 0.921), P = 0.005) and modified mortality (OR (95% CI): 0.740 (0.573 - 0.957), P = 0.022). CONCLUSION: Less amount of psoas muscle (PM) was found to be a significant risk factor for the prognosis of patients with TBI. PM was a better prognostic marker than skeletal muscle (SM) in patients with TBI. Further studies are needed to increase our understanding of sarcopenia and TBI.

A Comprehensive Analysis of the Association of Psoas and Masseter Muscles with Traumatic Brain Injury Using Computed Tomography Anthropometry.

OBJECTIVE: Psoas and masseter muscles are known markers of sarcopenia. However, the relative superiority of either muscle as a marker is unclear. Therefore, this study analyzed the two muscles in patients with a prognosis of traumatic brain injury (TBI). METHODS: Patients with TBI visiting a regional trauma center between January 2017 and December 2018 were selected, and their medical records were reviewed. TBI patients with an abbreviated injury score (AIS) of 4 or 5 were selected. Patients with an AIS of 4 or 5 at the chest, abdomen, and extremity were excluded. Patients with a hospital stay of 1 to 2 days were excluded. Both muscle areas were measured based on the initial computed tomography. The psoas muscle index (PMI) and the masseter muscle index (MMI) were calculated by dividing both muscle areas by height in meters squared (cm2/m2). These muscle parameters along with other medical information were used to analyze mortality and the Glasgow outcome scale (GOS). RESULTS: A total of 179 patients, including 147 males (82.1%), were analyzed statistically. The mean patient age was 58.0 years. The mortality rate was 16.8% (30 patients). The mean GOS score was 3.7. Analysis was performed to identify the parameters associated with mortality, which was a qualitative study outcome. The psoas muscle area (16.9 vs. 14.4 cm2, p=0.028) and PMI (5.9 vs. 5.1 cm2/m2, p=0.004) showed statistical differences between the groups. The PMI was also statistically significant as a risk factor for mortality in logistic regression analysis (p=0.023; odds ratio, 0.715; 95% confidence interval, 0.535-0.954). Quantitative analyses were performed with the GOS scores. Bivariate correlation analysis showed a statistically significant correlation between PMI and GOS scores (correlation coefficient, 0.168; p=0.003). PMI (p=0.004, variation inflation factor 1.001) was significant in multiple regression analysis. The masseter muscle area and MMI did not show significance in the study. CONCLUSION: Larger PMI was associated with statistically significant improved survival and GOS scores, indicating its performance as a superior prognostic marker. Further analyses involving a larger number of patients, additional parameters, and more precise settings would yield a better understanding of sarcopenia and TBI.

3D-structural change of nasopharynx following adenoidectomy: 10-year serial data in a single hospital.

PURPOSE: Scar contracture commonly refers to decreased function in the scar area, whereas scar contraction refers to shortening of the scar length compared to the original wound. Wound scar remodeling occurs during months to years of wound healing to form a mature scar. Serial reports about patients who had undergone adenoidectomy are rare. Thus, the objective of this study was to evaluate some parameters of air way passage in patients who had undergone post adenoidectomy. METHODS: Data of patients who have undergone adenoidectomy between 2000 and 2002 in our hospital were obtained. A total of 154 head and neck CT scans from an adenoidectomy group and a control group were analyzed. We measured lengths of several areas, including the width of posterior wall of nasopharynx, the widest diameter in the upper air way, the length between both Eustachian tubes, the length between both pharyngeal recesses, and the anterior to posterior diameter of the nasopharynx. This study was approved by Institutional Review Board (IRB) of the Department of Otolaryngology Head and Neck Surgery of Catholic University (approval number: UC18RESI0130). RESULTS: There were significant differences in the following parameters between the two groups: the width of posterior wall of nasopharynx and the length between both pharyngeal recesses. CONCLUSION: Extensive removal of soft tissue or injured muscle layer during surgery might be one of the reasons for the narrowing of airway. Keeping in mind not to make much injury the soft tissue or muscles during adenoidectomy is very important for the long-term outcome of this surgery.

Applicability of the masseter muscle as a nutritional biomarker.

Nutritional assessment is feasible with computed tomography anthropometry. The abdominal muscle at the L3 vertebra is a well-known nutritional biomarker for predicting the prognosis of various diseases, especially sarcopenia. However, studies on nutritional assessment of the brain using computed tomography are still scarce. This study aimed to investigate the applicability of the masseter muscle as a nutritional biomarker.Patients who underwent simultaneous brain and abdominopelvic computed tomography in the emergency department was retrospectively analyzed. We assessed their masseter muscle 2 cm below the zygomatic arch and abdominal muscle at L3 via computed tomography anthropometry. The skeletal muscle index, prognostic nutritional index, and other nutritional biomarkers were assessed for sarcopenia using the receiver operating characteristic curve analysis.A total of 314 patients (240 men and 72 women) were analyzed (mean age, 50.24 years; mean areas of the masseter and abdominal muscles, 1039.6 and 13478.3 mm, respectively). Masseter muscle areas significantly differed in sarcopenic, obese, and geriatric patients (P < .001). The areas under the curve of the masseter muscle in sarcopenic, geriatric, and obese patients were 0.663, 0.686, and 0.602, respectively. Multivariable linear regression analysis showed a correlation with the abdominal muscle area, weight, and age.The masseter muscle, analyzed via computed tomography anthropometry, showed a statistically significant association with systemic nutritional biomarkers, and its use as a nutritional biomarker would be feasible.

Reconstruction of Medial Wall Blowout Fracture Defect with a Combination of Resorbable Meshed Plate and Cancellous Bone Allograft.

BACKGROUND: Various materials are available for the reconstruction of bone defects in cases of medial wall blowout fracture. This study was conducted to assess the efficacy of the combination of a resorbable meshed plate and cancellous bone allograft. METHODS: From March 2014 to March 2017, a total of 111 patients were evaluated. Sixty-three patients received reconstruction surgery with porous polyethylene plates (control group) and the other forty-eight patients underwent operation with a resorbable meshed plate plus allogenic cancellous bone (combined group). The results were assessed by exophthalmometric measurements, width, and volume discrepancies as compared with the unaffected orbit, and operation time. RESULTS: The difference in exophthalmometric measurements between the affected and unaffected orbits were 0.94 ± 0.70 mm in the control group and 1.05 ± 0.73 mm in the combined group without statistical significance (p = 0.425). In the analysis of computed tomography images, the width discrepancy was 1.55 ± 0.86 mm and 1.08 ± 0.69 mm, respectively (p = 0.003); however, the volume discrepancy demonstrated no statistically significant difference (2.58 ± 1.40 cm3 versus 2.20 ± 1.80 cm3; p = 0.209). Operation time was significantly shorter in the combined group as compared with the control group (43.0 ± 7.0 versus 38.3 ± 7.0 minutes; p = 0.001). CONCLUSION: The combination material composed of resorbable meshed plate and cancellous bone allograft made reconstruction surgery of medial wall blowout fracture easier and quicker to perform with long-lasting results.

Ultrasound-Guided Percutaneous Biopsy of the Native Kidney: An Axial Approach Along Brödel Avascular Plane of the Lower Pole.

PURPOSE: This study demonstrates the feasibility and safety of the axial approach for real-time ultrasound-guided percutaneous renal biopsy along Brödel avascular plane. METHODS: In this retrospective analysis of 41 percutaneous biopsies performed from June 2014 to June 2015, patients' medical records, pathology results, complication rate, and pain score before and during the procedure were reviewed. RESULTS: The average number of sampled glomeruli was 16.1 ± 7.2 (mean ± SD). There were no major complications. The 2 minor complications, transient macrohematuria and small perirenal hematoma, occurred at a rate of 4.89% but regressed spontaneously in both cases. CONCLUSIONS: The axial approach along Brödel avascular plane is a feasible alternative approach for percutaneous biopsy of the native kidney.